Doctor Answers: What are the Symptoms of E. Coli in Urine?

Escherichia coli, also known as E. coli, is one of the most well-known bacteria of all.  Even people who know little about science and medicine have heard of it.  But what is E. coli, and what symptoms can it cause?

This article addresses these questions; we conducted an interview with Dr. Alberto Parra to gain a deeper understanding of the symptoms of E. coli in urine. 

After reading, you will also understand when it is appropriate to consult a doctor, as well as some medical treatments and home remedies you can use. A medical doctor has reviewed the article to ensure accuracy.

Q. What is E. coli?

Dr. Parra answers: E. coli is the name of a bacterium that is found in commensal intestinal flora. This means the bacteria can be found in our intestines without causing harm. However, there are also variants of the same bacteria that are more aggressive and can cause different symptoms.

It is a gram-negative bacterium, and in addition to being found in the intestines, we can also see it in vegetables, undercooked meat, unpasteurized products, and contact with the soil. Among the intestinal pathogenic variants mentioned in different studies and reviews, we can find:

• Enterotoxigenic E coli (ETEC): leading cause of traveler’s diarrhea.
  
• Enterohemorrhagic E coli (EHEC): causes bloody diarrhea and can trigger kidney failure.
  
• Enteroinvasive E coli (EIEC): less common.
  
• Enteropathogenic E coli (EPEC): mainly affects young children and infants.
  
• Enteroaggregative E coli (EAEC): second most common cause of traveler’s diarrhea.
  
• Shiga toxin-producing E coli (STEC): responsible for more severe symptoms, including watery diarrhea and large outbreak episodes.
  

E. coli not only causes diarrhea and gastrointestinal problems. It can also affect the urinary tract, respiratory tract, and brain, particularly through uropathogenic and meningitis-specific strains.

Q. What are the symptoms of E. coli?

Dr. Parra answers: E. coli can cause gastrointestinal, urinary, respiratory, and neurological symptoms. The most common are gastrointestinal and urinary symptoms.

Intestinal E. coli infection symptoms include:

• Abdominal cramps
  
• Watery diarrhea
  
• Bloody diarrhea
  
• Traveler’s diarrhea
  
• Dehydration
  

Escherichia coli symptoms in urine (urinary tract infection) include:

• Urinary urgency
  
• Burning sensation or pain when urinating (a hallmark symptom of E. coli in urine)
  
• Decreased urine volume
  
• Increased urinary frequency
  
• Strong or foul-smelling urine
  
• Discolored urine (pink, red, or cloudy)
  
• Pelvic or lower back pain
  
• Fever and chills
  
• Nausea and vomiting
  
• A sensation of pressure in the pelvis
  

These symptoms of E. coli in urine infections should not be ignored, especially if they persist or are accompanied by systemic signs like fever.

Q. How long do E. coli symptoms last?

Dr. Parra answers: The duration depends on the strain and the individual’s immune response. After antibiotic treatment, most E. coli infections clear within a week. More aggressive strains may require longer treatment. Untreated infections can lead to complications, including sepsis in severe cases.

However, it doesn’t mean every E. coli infection needs to be treated. According to the CDC, most people with E. coli infection recover without antibiotics. However, if the bacteria has already migrated to the urine or another organ, it requires prompt antibiotic treatment. Escherichia coli symptoms in urine may persist longer in individuals with underlying conditions or those not treated promptly.

Q. What are the causes and risk factors of E. coli?

Dr. Parra answers: As mentioned above, E coli is an organism generally found in the intestinal flora. However, there are aggressive strains that can cause intestinal diseases. 

These can be found in contaminated food, contaminated water, and the feces of infected people, triggering E coli food poisoning symptoms.

Therefore, according to the CDC, the risk factors for intestinal infection are:

• unsanitary conditions
• incorrect food handling
• drinking unsafe water
• traveling to endemic countries and areas

In the case of E coli urinary tract infections, the leading cause is the migration of bacteria from the intestine to the urinary tract. The most common way is through direct contact, for example, due to improper wiping technique after a bowel movement.

Thus, urinary tract infections are more common in women than men. Women have a shorter urethral duct, so bacteria do not have to travel as far to reach the bladder and colonize the mucosa.

Sexual contact can also be a route of entry to a urinary tract infection, especially in a woman. This is because the urinary meatus is very close to the vagina and anus.

Similarly, holding urine for a long time can cause E. coli urinary tract infection. This is because, by continuously urinating, the body sweeps out the bacteria contained in the urethra. 

By decreasing urinary frequency or holding urine for a long time, you are shutting down this defense mechanism.

Some risk factors for E coli urinary tract infections are:

• Menopause: because estrogen has been shown to be a protective factor against urinary tract infections.
• Diabetes: because increased blood sugar is also reflected in the urine. In addition, people with diabetes often have immune problems.
• Contraceptives such as diaphragms and condoms with spermicide. The latter can also destroy the normal flora that protects us from infections.
• Pregnancy, especially between 6 and 24 weeks, due to hormonal changes that facilitate the passage of E coli to the urinary tissue. In addition, as the uterus grows, it puts pressure on the bladder, decreasing its storage capacity.
• Prostate enlargement, which decreases the flow of urine and does not allow complete bladder emptying.
• Kidney stones, which besides blocking the flow of urine, also cause damage to the mucosa of the urinary tract and make it susceptible to infections.

Q. When should you see a doctor about E. coli symptoms?

Dr. Parra answers: Seek medical attention if you experience:

• Diarrhea for more than 3 days
  
• Diarrhea with high fever
  
• Bloody diarrhea
  
• Persistent vomiting
  
• Signs of dehydration
  
• Symptoms of E. coli in urine: burning, pelvic pain, fever, or foul-smelling urine
  

Escherichia coli symptoms in urine require prompt evaluation to prevent complications like kidney infections. In men, symptoms may also overlap with prostatitis.

Q. What are the treatments for E. coli infections?

Dr. Parra answers: Treatment depends on the infection type:

E. coli is a bacterium; the only way to treat it is through antibiotics. Antibiotics are mainly recommended in cases of E coli-related urinary tract infection. Azithromycin, Rifaximin, and ciprofloxacin can be used to treat the infection.

A physician must prescribe these antibiotics, as their use will depend on the severity of the case and the prevalence of antibiotic resistance in the area where you live. 

For example, a recent study showed an alarming rate of resistance against trimethoprim sulphamethoxazole of 25%. In another study, the same antibiotic gave a 50% chance of resistance, as shown in the following table:

Antibiotic	Chance of resistance
Tetracycline	94%
Trimethoprim/Sulfamethoxazole	50%
Cefuroxime	50%
Amoxicillin and piperacillin	33%
Ceftriaxone and cefoxitin	27%
Ciprofloxacin, levofloxacin, Augmentin	22%
Gentamicin	16%
Ceftazidime	11%
Cefotaxime	5%
Meropenem	0%

Therefore, only use antibiotics that your physician has prescribed. Antiseptic agents, such as nitrofurantoin, may also be prescribed in addition to antibiotic therapy.

In some cases, treating E coli infections does not include antibiotics, especially in intestinal diseases. 

When the main symptoms are diarrhea and dehydration, treatment should consist mainly of rehydration and drugs such as bismuth salicylate.

Q. What are effective home remedies for E. coli?

Dr. Alberto Parra answers: Here are the most effective home remedies for e. coli:

For gastrointestinal infections:

• Stay hydrated
  
• Sip fluids slowly
  
• Get plenty of rest
  
• Avoid antidiarrheals unless prescribed
  
• Avoid caffeine, alcohol, and fatty foods
  

For urinary tract infections:

• Drink plenty of water
  
• Avoid bladder irritants
  
• Use probiotics
  
• Try natural antimicrobials (garlic, honey, ginger, apple cider vinegar)
  

These home strategies help manage mild symptoms of E. coli in urine while awaiting medical treatment.

Q. How can E. coli infections be prevented?

Dr. Alberto Parra answers: Follow these steps:

• Wash hands frequently
• Cook meat thoroughly
• Wash fruits and vegetables
• Drink purified water
• Practice good personal hygiene
• Avoid unnecessary catheter use in healthcare settings
• For urinary prevention, proper genital washing and wiping techniques are key
• In case of repeated urinary infections, consider changes to contraception if using spermicides
  

Q. What is the conclusion about E. coli?

Dr. Parra answers: E. coli is common but potentially dangerous. While most strains are harmless, pathogenic variants can cause severe gastrointestinal or urinary infections. Recognizing Escherichia coli symptoms in urine, such as burning, frequent urination, and pelvic pain, is crucial for early treatment. Antibiotics are the cornerstone of urinary E. coli infection treatment, while hydration and symptom control help manage intestinal infections. Always consult a doctor for diagnosis and treatment.

Key FAQs on Escherichia Coli Symptoms in Urine

Q: Can E. coli in urine go away on its own?

Dr. Parra answers: While some E. coli infections affecting the digestive system can sometimes resolve on their own, this is not the case with urinary infections. If you have a urinary infection caused by E. coli, it is important to address it promptly. Treatment typically involves antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole, or amoxicillin-clavulanate as first-line options. Your doctor should determine the most appropriate antibiotic after examining you, considering your medical history, previous antibiotic treatments, and current allergies.

Remember that your urinary tract is meant to be free of bacteria. They shouldn’t be present, and your bladder and urethra are not designed to host these microorganisms. This is very different from the gastrointestinal tract, which has its own normal flora that competes with pathogenic bacteria and is specifically designed to host millions of bacterial agents. Therefore, having any bacteria in your urinary tract is a problem that is unlikely to resolve on its own.

In most cases, the opposite is true. According to the National Kidney Foundation, ignoring a urinary infection caused by E. coli can lead to symptoms worsening and the bacteria potentially invading the upper urinary tract. When the infection reaches the kidneys, symptoms change, and the condition becomes more serious, possibly resulting in kidney damage and systemic issues such as sepsis.

Q: Are there long-term effects of untreated E. coli urinary tract infections?

Dr. Parra answers: Yes, long-term effects of untreated E. coli urinary tract infections include pyelonephritis, kidney damage, sepsis, chronic prostatitis, and renal failure. Not all patients with prolonged E. coli infections will develop these conditions. It depends on their immune system, current health, age, and many other factors. However, there’s a possibility that E. coli travels to other organs, such as the prostate and kidneys, causing chronic infections and damage to their structures. Then, after reaching internal organs with high blood flow, E. coli can also cause systemic inflammation known as sepsis, which can be very dangerous. 

When it reaches the kidneys, E. coli infections cause pyelonephritis, a kidney infection characterized by inflammation and long-lasting damage to kidney tissue. Nephrons are complex structures within the kidneys, and this inflammation, if it persists for a long time, can lead to progressive kidney damage that may result in renal failure when extensive. 

Prostatitis is also commonly associated with untreated urinary tract infections. Studies show E. coli is the most common bacterial cause of prostatitis, typically triggering acute prostatitis. However, when the infection persists for an extended period or becomes resistant to treatment, it can lead to chronic prostatitis, which requires prolonged treatment to resolve.

Q: Can E. coli infection recur?

Dr. Parra answers: Yes, it is very common to experience a recurrence of an E. coli infection in the urinary tract, especially in women. Recurrent urinary tract infections are usually related to hygiene issues, sexual activity, and pH changes that create favorable conditions for urinary problems in women. In men, recurrent infections are less common, and when they do occur, they are typically caused by a structural or physiological abnormality, as shown in studies.

For example, some men may have a congenital defect in the urinary tract or a functional problem with the urinary tract muscles that leads to regurgitation or backflow of urine after voiding. In such cases, urine can reach the outer part of the urethra, which may contain bacteria, and then flow back into internal organs that are normally bacteria-free and not prepared to host them as normal flora. The bacteria find a suitable spot to grow and colonize, and because the defect persists even after completing antibiotic treatment, the infection often recurs.

It can also happen that treatment for a urinary tract infection fails, providing temporary symptom relief, but symptoms return after the treatment ends. In these cases, there is likely antibiotic resistance, and doctors may order a special urine analysis to identify bacteria and determine their sensitivities to antibiotics in order to select the most effective treatment.

Is E. coli contagious through urine?

Dr. Parra answers: No, E. coli and other urinary tract infections aren’t likely to spread through urine contact. These infections are usually transmitted through contact, but such contact rarely involves urine because it typically contains fewer bacteria than feces, soil, and other materials. While it’s possible to get a urinary tract infection from urine, for example, during some cases of sexual intercourse, there are no reported cases in the medical literature so far. Additionally, certain conditions can increase your risk of a urinary infection. 

Poor hygiene during sexual activity can introduce bacteria into the urinary tract, which may originate from feces, urine, or other sources. However, if you’re worried about contact with shared surfaces like toilets stained with urine from an infected person, rest assured it poses minimal risk and won’t cause an infection like contact with fecal matter or contaminated food would.

Even in pregnant women and immunocompromised individuals, transmission through urine remains rare. Still, studies and reviews show it’s advisable to practice good hygiene at all times, especially when in contact with someone who has an active infection. Wash your hands, wipe from front to back if you’re a woman, and thoroughly wash vegetables with plenty of water to prevent bacterial spread.

Our Medical Review Process

At Ben’s Natural Health, we prioritize accuracy, transparency, and scientific integrity. All health content is written by qualified medical professionals and undergoes review every 12 to 24 months to ensure it stays current and evidence-based. We cite only peer-reviewed research from reputable medical journals and provide full references and direct links to support our commitment to credibility. Learn more about our medical review process and research standards.

Our Editorial Guidelines

For more than 25 years, Ben’s Natural Health has been a reliable source of science-backed natural health information. Our editorial process is designed to uphold the highest standards of accuracy and trustworthiness. Every article is written by certified experts, doctors, nutritionists, dietitians, fitness professionals, and surgeons, and independently reviewed for accuracy. Contributor bios and credentials are clearly listed at the top of each article to ensure full transparency. Read more about our editorial standards.

Medical Disclaimer

The content on this website is intended for informational and educational purposes only and should not be taken as medical advice, diagnosis, or treatment. While our articles are developed and reviewed by licensed healthcare professionals, they may not reflect your unique health circumstances. Always consult a qualified medical professional with any questions or concerns. Do not delay or avoid seeking professional care based on information you’ve read here. Your use of this content is at your own risk.